Form G-28 Notice of Entry of Appearance as Attorney or Accredited

Notice of Entry of Appearance
as Attorney or Accredited Representative

DHS
Form G-28

Department of Homeland Security

OMB No. 1615-0105
Expires 05/31/2021

Part 1. Information About Attorney or Accredited Representative
1.

DRAFT

USCIS Online Account Number (if any)

►

Name of Attorney or Accredited Representative
2.

Family Name (Last Name)

Given Name (First Name)

Middle Name

Address of Attorney or Accredited Representative
3.

Street Number and Name

Apt. Ste. Flr. Number

NOT FOR
PRODUCTION

City or Town

State

Province

ZIP Code

(USPS ZIP Code Lookup)

Country

Postal Code

Contact Information of Attorney or Accredited Representative
4.

Daytime Telephone Number

5.

Mobile Telephone Number (if any)

6.

Email Address (if any)

7.

Fax Number (if any)

Part 2. Eligibility Information for Attorney or Accredited Representative
Select all applicable items.
1.

A.

I am an attorney eligible to practice law in, and a member in good standing of, the bar of the highest courts of the
following states, possessions, territories, commonwealths, or the District of Columbia. If you need to provide
information for more than three jurisdictions, use the space provided in Part 6. Additional Information.
Jurisdiction

Jurisdiction

09/21/2021

Jurisdiction

Bar Number (if applicable)

Bar Number (if applicable)

Bar Number (if applicable)

B.

I (select only one box)
am not
am
subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law. If
you are subject to any orders, use the space provided in Part 6. Additional Information to provide an explanation.

C.

Name of Law Firm or Organization (if applicable)

Form G-28 09/17/18

Page 1 of 5

Part 2. Eligibility Information for Attorney or Accredited Representative (continued)
2.

A.

B.

3.

I am an accredited representative of the following qualified nonprofit religious, charitable, social service, or similar
organization established in the United States and recognized by the Department of Justice in accordance with 8 CFR
part 1292.

DRAFT

Name of Recognized Organization

I am associated with

C.

Date of Accreditation (mm/dd/yyyy)

,

the attorney or accredited representative of record who previously filed Form G-28 in this case, and my appearance as an
attorney or accredited representative for a limited purpose is at their request.
4.

A.
B.

I am a law student or law graduate working under the direct supervision of the attorney or accredited representative of
record on this form in accordance with the requirements in 8 CFR 292.1(a)(2).
Name of Law Student or Law Graduate

NOT FOR
PRODUCTION

Part 3. Notice of Appearance as Attorney or Accredited Representative

If you need extra space to complete this section, use the space provided in Part 6. Additional Information.
This appearance relates to immigration matters before (select only one box):
1.

A.
B.

2.

A.
B.

3.

A.
B.

U.S. Citizenship and Immigration Services (USCIS)

List the form numbers or specific matter in which appearance is entered.

U.S. Immigration and Customs Enforcement (ICE)

List the specific matter in which appearance is entered.

U.S. Customs and Border Protection (CBP)
List the specific matter in which appearance is entered.

►

4.

Receipt Number (if any)

5.

I enter my appearance as an attorney or accredited representative at the request of the (select only one box):
Applicant

09/21/2021

Petitioner

Requestor

Beneficiary/Derivative

Respondent

Information About Client (Applicant, Petitioner, Requestor, Beneficiary or Derivative, Respondent, or
Authorized Signatory for an Entity)
6.

Family Name (Last Name)

7.

Name of Entity (if applicable)

8.

Title of Authorized Signatory for Entity (if applicable)

9.

Client's USCIS Online Account Number (if any)

10.

Client's Alien Registration Number (A-Number) (if any)

►

Form G-28 09/17/18

Given Name (First Name)

Middle Name

► A-

Page 2 of 5

Part 3. Notice of Appearance as Attorney or Accredited Representative (continued)
Client's Contact Information
11.

Daytime Telephone Number

13.

Email Address (if any)

DRAFT
12.

Mobile Telephone Number (if any)

Mailing Address of Client
NOTE: Provide the client's mailing address. Do not provide the business mailing address of the attorney or accredited representative
unless it serves as the safe mailing address on the application or petition being filed with this Form G-28.
14.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

NOT FOR
PRODUCTION

Province

Postal Code

Country

Part 4. Client's Consent to Representation and Signature
Consent to Representation and Release of Information

I have requested the representation of and consented to being represented by the attorney or accredited representative named in Part 1.
of this form. According to the Privacy Act of 1974 and U.S. Department of Homeland Security (DHS) policy, I also consent to the
disclosure to the named attorney or accredited representative of any records pertaining to me that appear in any system of records of
USCIS, ICE, or CBP.

Options Regarding Receipt of USCIS Notices and Documents
USCIS will send notices to both a represented party (the client) and their attorney or accredited representative either through mail or
electronic delivery. USCIS will send all secure identity documents and Travel Documents to the client's U.S. mailing address.
If you want to have notices and/or secure identity documents sent to your attorney or accredited representative of record rather than to
you, please select all applicable items below. You may change these elections by submitting a new Form G-28 to USCIS.
1.

09/21/2021

A.

I request that USCIS send original notices on an application or petition to the business address of my attorney or
accredited representative as listed in this form.

B.

I request that USCIS send any secure identity document (Permanent Resident Card, Employment Authorization
Document, or Travel Document) that I receive to the U.S. business address of my attorney or accredited
representative (or to a designated military or diplomatic address in a foreign country (if permitted)).
NOTE: If your notice contains Form I-94, Arrival-Departure Record, USCIS will send the notice to the U.S.
business address of your attorney or accredited representative. If you would rather have your Form I-94 sent directly
to you, select Item Number 1.C.

C.

I request that USCIS send my notice containing Form I-94, Arrival-Departure Record, to me at my U.S. mailing address.

Signature of Client or Authorized Signatory for an Entity
2.

Signature of Client or Authorized Signatory for an Entity

Form G-28 09/17/18

Date of Signature (mm/dd/yyyy)

Page 3 of 5

Part 5. Signature of Attorney or Accredited Representative
I have read and understand the regulations and conditions contained in 8 CFR 103.2 and 292 governing appearances and
representation before DHS. I declare under penalty of perjury under the laws of the United States that the information I have provided
on this form is true and correct.

DRAFT

1.

Signature of Attorney or Accredited Representative

Date of Signature (mm/dd/yyyy)

2.

Signature of Law Student or Law Graduate

Date of Signature (mm/dd/yyyy)

NOT FOR
PRODUCTION
09/21/2021
Form G-28 09/17/18

Page 4 of 5

Part 6. Additional Information
If you need extra space to provide any additional information within this form, use the space below. If you need more space than what
is provided, you may make copies of this page to complete and file with this form or attach a separate sheet of paper. Type or print
your name at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and
sign and date each sheet.
1.

Family Name (Last Name)

2.

A.

Page Number

DRAFT
Given Name (First Name)

B.

Part Number

C.

Middle Name

Item Number

D.

3.

A.

D.

4.

A.

NOT FOR
PRODUCTION
Page Number

B.

Part Number

C.

Item Number

Page Number

B.

Part Number

C.

Item Number

Page Number

B.

Part Number

C.

Item Number

D.

5.

A.

09/21/2021

D.

6.

A.

Page Number

B.

Part Number

C.

Item Number

D.

Form G-28 09/17/18

Page 5 of 5